Questions to Ask Your Pediatrician.txt

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Questions to Ask Your 
Pediatrician About Autism 

P. Gail Williams, M.D. 

Associate Professor of Pediatrics 

University of Louisville 


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Questions to ask your pediatrician when you suspect 
the diagnosis 
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Questions to ask your pediatrician once the diagnosis 
is made 


Overview 


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What are the signs of autism? 
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Communication impairments 
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Social skills deficits 
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Limited range of interests and activities 


 


When You Suspect the Diagnosis 


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Frequently ignore language 
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Deficits in nonverbal communication (eye gaze, 
pointing and gesturing, facial expression, etc.) 
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Echolalia 
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Impairments in receptive and expressive language 
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Language regression in 1/3 of cases 


Communication in Young Children 
with Autism 


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�Off in his own world� 
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Lack of joint attention, shared enjoyment 
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Difficult to engage in interactive play 
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Social deficits often most evident with same age 
peers 


Social Interaction in Young Children 
with Autism 


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Minimal or atypical toy play 
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Strong preoccupations 
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Perseverative activities or speech 
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Insistence on routine, rituals 
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Abnormal response to sensory input 


Range of Activities in Young Children 
with Autism 


First Signs 


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Can we screen for autism? 


 

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The American Academy of Pediatrics has 
recommended specific autism screening at 18 and 24 
month well child checks. 
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Many screening tools are available 
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Perhaps the most widely used is M-CHAT 
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Readily available and sensitive 


When You Suspect the Diagnosis of 
Autism 


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What services are available? 


 

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First Steps provides services for any child with 
developmental disabilities below the age of 3 
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Includes speech therapy, occupational therapy, 
developmental intervention, behavior interventions 
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The public school system provides preschool and 
therapy services after age 3 
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Don�t wait to start services 


When You Suspect the Diagnosis 


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How can I get definitive diagnosis? 


 

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Facilities throughout the state can provide 
evaluations; most are in academic centers 
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Evaluation should include thorough history, 
behavioral observations, developmental measures, 
autism diagnostic tool 
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Medical evaluation also helpful 


When You Suspect the Diagnosis 


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What causes autism? 


 

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Etiology still unknown 
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Neurobiologic disorder due to differences in brain 
development 
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Strong genetic component 
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Possible environmental factors 


Once the Diagnosis is Made 


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How common is autism? 


 

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Current research indicates prevalence rate of 1 in 88 
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Dramatic increase in prevalence over last 20 to 30 
years 
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In part, due to increased awareness, better diagnostic 
tools, increased services, etc. 


Once the Diagnosis is Made 


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What are the risks for having a second child with 
autism? 


 

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Previously quoted as 3 to 8% 
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Recent study of siblings of children with autism 
indicated recurrence risk of nearly 19% 


Once the Diagnosis is Made 


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Should any medical tests be done? 


 

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Autism is associated with other medical and genetic 
conditions in 10 to 15% of cases 
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Genetic testing recommended to include Fragile X 
DNA testing, microarray chromosome analysis 
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Sleep deprived EEG if history of language regression 
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Consider MRI of brain 


Once the Diagnosis is Made 


Medical Tests 


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Are there any medical conditions more common in 
autism? 


 

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Intellectual disability is identified in approximately 
50% of children with autism 
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Seizures are present in approximately one-third of 
children with autism 


Once the Diagnosis is Made 


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What about vaccinations and autism? 


 

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First concerns were raised about measles vaccine and 
autism 
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Initial work discredited; numerous studies showed no 
relationship between autism and measles vaccine 
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Later concern about thimerosol and autism 
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Studies showed no relationship; no longer used as 
preservative in vaccines 


Once the diagnosis is made 


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What about sleep? 


 

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Many children with ASD have sleep problems 
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Disruption in Circadian rhythms 
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Difficulty falling and staying asleep, waking early 
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Behavioral interventions first line 
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Melatonin may be helpful 


Once the Diagnosis is Made 


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What about eating habits? 


 

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Often very limited food repertoires 
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Can be based on sensory issues 
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Behavioral approach often very effective 
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Systematic approach to introducing new foods 
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Provide rewards and exposure, not trying to force 


Once diagnosis is made 


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What is the treatment for autism? 
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Primarily educational and behavioral 
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24 evidence based practices 
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Speech therapy 
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Occupational therapy 
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Social skills training 


Once the Diagnosis is Made 


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What about behavioral problems associated with 
autism? 


 

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Behavioral problems common 
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Attention problems and hyperactivity 
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Anxiety and depression 
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Marked irritability with mood lability, aggression, self 
injurious behavior 


Once the diagnosis is made 


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What role does medication have in the treatment of 
autism? 


 

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Medication does not address core symptoms of 
autism 
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Adjunctive to help with associated behavior problems 
that interfere with home, school and community 
function 


Once the diagnosis is made 


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What medications are used to treat these behavioral 
problems? 


 

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Medications for ADHD: stimulants, nonstimulants 
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Medications for depression/anxiety: SSRI�s 
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Medications for severe irritability: atypical 
antipsychotics 


Once the diagnosis is made 


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What should I ask before starting medication? 


 

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What behaviors are being targeted by the 
medication? 
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What side effects are possible? 
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What monitoring should be done? 
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How will we measure progress on medication? 


Once the diagnosis is made 


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What about alternative biomedical interventions? 


 

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Wide variety available, including dietary changes, 
vitamins, and supplements 
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Others: hyperbaric oxygen, chelation therapy 
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Little research available 


Once the diagnosis is made 


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What should I consider if I want to try biomedical 
interventions? 


 

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Potential benefits 
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Potential side effects 
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Expense 
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Role in overall program 
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Evidence supporting intervention 


Once the diagnosis is made 


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What can I expect in the future? 


 

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Progress, but variable in rate 
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Factors in prognosis: intelligence, temperament, 
language, early intervention 
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Access services and supports to optimize child�s 
potential, but realize that each child� potential is 
different 


 

Once the diagnosis is made 


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Where do I go from here? 
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Educate yourself about autism 
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Access appropriate educational and behavioral 
services 
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Become an advocate for your child 
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Resources: KATC Family Guide, AAP, Autism Speaks, 
CDC, local family support groups 


Once the Diagnosis is Made